Ergospirometry and right heart catheterization demonstrated better efficacy for screening for pulmonary arterial hypertension (PAH) in patients with scleroderma than current methods, according to a study recently published in Medicina Clínica.
“The incorporation of ergospirometry in the PAH screening algorithm in high risk populations such as those with scleroderma could increase the sensitivity of screening, and speed up the diagnosis,” the authors wrote.
This prospective study included 52 patients previously diagnosed with scleroderma from a single center in Spain between 2018 and 2019 who underwent ergospirometry along with the annual standardized screening to later compare the sensitivities of both approaches.
To confirm the presence of PAH in these patients, the researchers performed right heart catheterization at rest and upon exertion whenever a PAH diagnosis was inconclusive with the results at rest.
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Of all 52 participants, 16 had results suggestive of PAH on ergospirometry. Of these, right heart catheterization at rest and exertion confirmed the diagnosis in 5 and 7 cases, respectively.
The latter approach exhibited a sensitivity of 100%. Importantly, of the 16 patients who initially screened positive for PAH with ergospirometry, only 10 were also detected by the standardized screening, showcasing a sensitivity of 70%.
The only screening system currently established and standardized in healthcare centers utilizes the DETECT algorithm. This tool consists of a 2-step process.
Firstly, there is a physical assessment aimed at detecting telangiectasias, as well as laboratory tests, including measurements of natriuretic peptide, anticentromere antibodies, and uric acid, electrocardiography, and spirometry. Individuals who score 300 or more in the first phase undergo an echocardiogram. Lastly, patients that meet the final score threshold further undergo right heart catheterization at rest.
“The right heart catheterization on exertion in patients with a high suspicion of exertional PAH demonstrated in the ergospirometry, and normal pulmonary hemodynamics at rest is safe and allows earlier detection of PAH, although the definition of exertional PAH needs to be agreed upon,” the study authors concluded.
Sánchez-Aguilera Sánchez-Paulete P, Lázaro Salvador M, Berenguel Senén A, Méndez Perles C, Rodríguez Padial L. Role of cardiopulmonary exercise test in early diagnosis of pulmonary hypertension in scleroderma patients. Med Clin (Barc). Published online August 30, 2022. doi:10.1016/j.medcli.2022.07.012